Alcohol and Women: What is the Role of Biologic Factors?

Corticotropin releasing hormone receptor 1 in the medial prefrontal cortex mediates aversion resistant alcohol intake

RATIONALE

Alcohol consumption despite negative consequences is a core symptom of Alcohol Use Disorder. In animal models, this is studied by pairing aversive stimuli with alcohol access, and continuation of drinking under these conditions is known as aversion resistance. Previously, we found that female mice are more aversion resistant than males. Corticotropin releasing hormone (Crh) and the Crh receptor 1 (Crhr1) regulate stress-induced reinstatement, alcohol dependence, and binge-like drinking. However, the role of the Crh system in aversion resistance has not been assessed.

OBJECTIVES

We aimed to identify sex differences in the Crh system during quinine-adulterated alcohol intake.

METHODS

We used two-bottle choice and adulterated the alcohol solution with quinine. Next, we measured Crh and Crhr1 levels in brain tissue using real-time polymerase chain reaction (RT-qPCR) and RNAscope in situ hybridization. We then infused a Crhr1 antagonist into the medial prefrontal cortex (mPFC) prior to quinine-alcohol intake.

RESULTS

After quinine-alcohol consumption, females exhibited increased mPFC Crhr1 mRNA levels as measured by RT-qPCR. This was confirmed with greater anatomical specificity using RNAscope, with females exhibiting an increased number of Crhr1 + cells in the dorsomedial PFC and the ventromedial PFC. mPFC Crhr1 antagonist treatment reduced quinine-alcohol consumption in females but did not impact consumption in males. Quinine-free alcohol intake was unaffected by Crhr1 antagonist treatment.

CONCLUSIONS

Our findings suggest that Crhr1 in mPFC plays a role in aversion resistant alcohol intake in females. Future experiments will examine the sources of Crh innervation to the mPFC and their distinct roles in alcohol seeking.

The Etiologic, Theory-Based, Ontogenetic Hierarchical Framework of Alcohol Use Disorder: A Translational Systematic Review of Reviews

Modern nosologies (e.g., ICD-11, DSM-5) for alcohol use disorder (AUD) and dependence prioritize reliability and clinical presentation over etiology, resulting in a diagnosis that is not always strongly grounded in basic theory and research. Within these nosologies, DSM-5 AUD is treated as a discrete, largely categorical, but graded, phenomenon, which results in additional challenges (e.g., significant phenotypic heterogeneity). Efforts to increase the compatibility between AUD diagnosis and modern conceptualizations of alcohol dependence, which describe it as dimensional and partially overlapping with other psychopathology (e.g., other substance use disorders) will inspire a stronger scientific framework and strengthen AUD's validity. We conducted a systematic review of 144 reviews to integrate addiction constructs and theories into a comprehensive framework with the aim of identifying fundamental mechanisms implicated in AUD. The product of this effort was the Etiologic, Theory-Based, Ontogenetic Hierarchical Framework (ETOH Framework) of AUD mechanisms, which outlines superdomains of cognitive control, reward, as well as negative valence and emotionality, each of which subsume narrower, hierarchically-organized components. We also outline opponent processes and self-awareness as key moderators of AUD mechanisms. In contrast with other frameworks, we recommend an increased conceptual role for negative valence and compulsion in AUD. The ETOH framework serves as a critical step towards conceptualizations of AUD as dimensional and heterogeneous. It has the potential to improve AUD assessment and aid in the development of evidence-based diagnostic measures that focus on key mechanisms in AUD, consequently facilitating treatment matching.

Stressful life events and alcohol consumption in pregnant women: A cross-sectional survey

BACKGROUND

Psychological stress in pregnancy has been related to different adaptations (physical, emotional and social) of the woman's life during this period. Although maternal stress is a common occurrence in pregnancy, studies indicate that the high levels of stressful life events are a predisposing factor to alcohol consumption in pregnant women. Though postnatal maternal emotional distress has been extensively investigated, little is known about the association between stressful life events and maternal risk behaviors during pregnancy.

OBJECTIVES

The purpose of this study is to verify the association between stressful life events and alcohol consumption in pregnant women.

DESIGN AND PARTICIPANTS

This is a cross-sectional survey using a convenience sample of 449 women in the third trimester of pregnancy. The participants were recruited in a public maternity hospital in the city located in the state of Sao Paulo, Brazil.

METHODS

A semi-structured interview was used to assess alcohol use and stressful life events of the respondent's life. The semi-structured interview included the following instruments: a socio-demographic questionnaire, inventory for the evaluation of the stressful life events (Interview for Recent life events -IRLE), the questionnaire Tolerance, Annoyed, Cut-down, Eye-Opener (T-ACE) for the use of alcohol, the International Classification of Diseases (ICD-10) criteria for alcohol-related disorders, and the evaluation of consumption before and during each gestational trimester.

RESULTS

Pregnant women diagnosed with alcohol abuse and alcohol dependence according to ICD-10 and with risk consumption, according to T-ACE screening, had a higher occurrence of stressful life events than the group without this diagnosis (p < 0.001). The following stressful life events were more frequent among women with alcohol problems: "Major financial difficulties," "Loss or theft of objects", "Serious argument with non-resident/close family member", "Serious argument with family members," and "Marital separation" with the latter about eight times more common in this group.

CONCLUSION

The results suggest an association between stressful life events and dependence or risk consumption of alcohol in pregnant women. The evaluation of stressful life events by the nursing team can help pregnant women to identify or strengthen healthy coping styles in the face of stress, thus intervene, and avoid alcohol consumption during pregnancy.

Trajectories of Drinking Urges During Individual- and Couple-based Cognitive-Behavioral Treatment for Alcohol Use Disorders

Individuals receiving treatment for alcohol use disorders (AUDs) often experience urges to drink, and reductions in drinking urges during cognitive-behavioral therapy (CBT) predict better treatment outcomes. However, little previous work has examined patterns of daily drinking urges during treatment. The present study examined patterns of change in daily drinking urges among participants in two randomized clinical trials of males (N = 80 with 4401 daily recordings) and females (N = 101 with 8011 daily recordings) receiving individual- or couples-based CBT. Drinking urges were common during treatment, occurring on 45.1% percent of days for men and 44.8% for women. Drinking urges and alcohol use for both genders decreased substantially during the course of treatment. Both genders had increases in drinking urges as more time elapsed since attending a treatment session. For men, this increase was most pronounced at the beginning of treatment, but for women it was most pronounced near the end of treatment. Alcohol use and drinking urges were both more likely to occur on weekends. The results suggest that these times may lead to higher risk for drinking, and clients may benefit from high-risk planning that is focused on these times.

Sex and age differences in heavy binge drinking and its effects on alcohol responsivity following abstinence

Binge drinking during adolescence may perturb the maturing neuroenvironment and increase susceptibility of developing an alcohol use disorder later in life. In the present series of experiments, we utilized a modified version of the drinking in the dark-multiple scheduled access (DID-MSA) procedure to study how heavy binge drinking during adolescence alters responsivity to ethanol later in adulthood. Adult and adolescent C57BL/6J (B6) and DBA/2J (D2) males and females were given access to a 20% ethanol solution for 3 hourly periods, each separated by 2h of free water access. B6 adults and adolescents consumed 2 to 3.5 g/kg ethanol an hour and displayed significant intoxication and binge-like blood ethanol concentrations. There was an interaction of sex and age, however, driven by high intakes in adult B6 females, who peaked at 11.01 g/kg. Adolescents of both sexes and adult males never consumed more than 9.3 g/kg. D2 mice consumed negligible amounts of alcohol and showed no evidence of intoxication. B6 mice were abstinent for one month and were retested on the balance beam 10 min following 1.75 g/kg ethanol challenge (20%v/v; i.p). They were also tested for changes in home cage locomotion immediately following the 1.75 g/kg dose (for 10 min prior to balance beam). Although there was no effect of age of exposure, all mice with a binge drinking history demonstrated a significantly dampened ataxic response to an ethanol challenge. Female mice that binge drank during adulthood showed a significantly augmented locomotor response to ethanol when compared to their water drinking controls. This alteration was not noted for males or for females that binge drank during adolescence. These results highlight the importance of biological sex, and its interaction with age, in the development of behavioral adaptation following binge drinking.